The treatment of Hyperadrenocorticism in dogs

Hyperadrenocorticism (HAC) is a challenging, but rewarding disease to diagnose and treat. It is a commonly diagnosed canine endocrinopathy with an average of one new case per vet presenting every six months¹.

HAC can be either iatrogenic or naturally occurring (spontaneous).

Most spontaneous cases of HAC (80-85%) are caused by hypersecretion of ACTH by a tumour in the pituitary gland. This is termed canine pituitary-dependent hyperadrenocorticism (PDH).

The remainder of spontaneous cases (15-20%) are caused by a glucocorticoid producing adenoma or carcinoma within the adrenal gland itself. This form of the disease is known as adrenal-dependent hyperadrenocorticism (ADH).

In all cases of HAC, prolonged exposure to high plasma concentrations of glucocorticoids, mainly cortisol, cause a complex of physical and biochemical changes.

Identify

HAC can be remembered as “The P Disease” as the seven most common presenting signs of identified by vets¹ are:

1. Polyuria
2. Polydipsia
3. Polyphagia
4. Pot belly
5. AloPecia
6. Panting
7. Paper-thin skin

Diagnose

Diagnosis of HAC usually begins by undertaking routine haematology, biochemistry and urinalysis on a dog with consistent clinical signs. A definitive diagnosis is then made based on results of specific endocrine testing. The confirmatory tests most commonly undertaken are the ACTH Stimulation Test and the Low Dose Dexamethasone Suppression Test.

For detailed information on performing and interpreting confirmatory testing, please refer to the Diagnosis Flowchart.

Complications of untreated HAC include diabetes mellitus, urinary tract infections, urolithiasis, hypertension, pancreatitis and thromboembolic disease².

Treat and Monitor

Vetoryl® is the only veterinary licensed pharmaceutical treatment available for dogs diagnosed with HAC.  It contains trilostane which selectively and reversibly inhibits the enzyme system 3ß-hydroxysteroid dehydrogenase, involved in the synthesis of several steroids including cortisol and aldosterone.

The starting dose for treatment is approximately 2mg/kg once daily, based on available combinations of capsule sizes. Vetoryl is available in four capsule strengths (10, 30, 60 and 120mg) which provide dose flexibility and tailored treatment for every dog.
 

The dose of Vetoryl should be titrated according to individual response as determined by monitoring (see Treatment and Monitoring Flowchart).

If a dose increase is required, use combinations of capsule sizes in order to slowly increase the once daily dose. Administer the lowest dose necessary to control the clinical signs.

Timeline of improvement

The anticipated clinical response after treatment with Vetoryl is shown below:

At the end of Dechra’s six month clinical trial of 60 dogs, no more than 15% of dogs exhibited any of the clinical signs associated with HAC³.

Compliance

Vetoryl is rated as “very effective” or “effective” by 98% of vets¹. By recommending treatment, you can be confident Vetoryl will transform the quality of life for dogs and owners – life restored on every level.

Research has shown that 94% of treated dogs remain on Vetoryl – bonding clients to your practice – and that owner education and regular contact are both key ways to boost compliance and aid retention¹.

Dechra are on hand to offer support when needed with technical back-up that is highly valued by vets¹.

Support material for both clinician and client including client log books, waiting room posters, case studies and client information books can all be downloaded or ordered from the Dechra website by visiting http://www.dechra.co.uk/therapy-areas/companion-animal/endocrinology/canine-hyperadrenocorticism

The Dechra Technical Team are also available to provide clinical support – they can be contacted directly by phone: 01939 211200 or by email: technical@dechra.com. The team are happy to provide advice on individual cases, as well as to deliver further information about any of Dechra’s products as required.

_{VETORYL: Vetoryl contains Trilostane UK POM-V  IE POM
Dechra Veterinary Products Ltd, Sansaw Business Park, Hadnall, Shrewsbury, Shropshire, SY4 4AS Tel: 01939 211200
Web: www.dechra.co.uk
Registered Office: 24 Cheshire Avenue, Cheshire Business Park, Lostock Gralam, Northwich CW9 7UA.
Registered in England and Wales, Company Registration No.5385888.
Dechra Veterinary Products Limited is a trading business of Dechra Pharmaceuticals PLC.}